Strep Infections

As a child, I spent way too many hours at the family doctor's small office, a fire burning in my throat. He would take a look, diagnose strep throat, open a cabinet door on the wall behind him, and dispense a supply of penicillin. While this was a long time ago and the medical process has changed, the germ hasn't. Strep still thrives in our communities and among our children.

Types of Strep Infections

The bacteria called strep—Group A beta-hemolytic streptococcus, to use its formal name—is carried only by humans and, with rare exceptions, is spread only by close human contact.

Two types of people are infectious to others: those with active infections and the 3 to 10 percent of us who silently carry this germ in our noses and throats. Infants tend to be spared from strep infections due to protective antibodies from the mother that cross the placenta before birth. Older adolescents and adults are also usually spared the worst of strep as they have had time to develop some immunity from past infections. This leaves the middle group—young kids—to suffer the most.

Many parts of our bodies can be affected by a strep infection. Some of these infections are very serious, such as meningitis, joint infections, or severe pneumonias. One fairly commonly involved site is the skin, where strep can cause an infection called impetigo. Through a tiny, sometimes invisible, break in the skin, the strep bacteria (or another called the staphylococcus) gain access to the layers between the skin. Small bumps appear, then spread, forming a honey-colored, crusty rash. Most cases of impetigo occur in the summer and are found near the nose and mouth. Once impetigo is diagnosed, treatment is usually straightforward, involving either an oral antibiotic or a prescription-strength antibiotic ointment.

Strep's Claim to Fame: Pharyngitis, or Strep Throat

But those are the lesser known strep infections. It's the nasty sore throat (pharyngitis) that gives this germ its fame. Since most cases of strep throat occur in the winter and spring when many other germs causing sore throats are active, it can be a tricky task to sort through the various causes. Yet this is important, since the treatments are different. A few clinical differences help distinguish strep (a bacterial cause) from a virus.

The pain of a strep throat usually develops quickly over hours. A child who complains of a scratchy throat for days often just has a virus. A very runny nose, a cough, or sneezing also point to a cause other than strep: allergies, postnasal drip, or again, one of a number of cold viruses. The fever caused by strep can be impressive, 101 or 102 degrees Fahrenheit. The area in the back of the throat is often, but not always, very red, and the tonsils covered with a layer of pus called an "exudates." Lymph nodes along the sides of the neck enlarge in reaction to a strep pharyngitis. Other symptoms that point toward strep are stomach pain, headache, and loss of appetite.